Current Diabetes Reviews - Volume 19, Issue 8, 2023

Diabetes mellitus has become a global pandemic progressively rising and affecting almost every household in all world regions. Diet is a significant root cause of type II diabetes; thus, the significance of dietary interventions in preventing and managing the disease cannot be neglected. Lowering the glycemic impact of diet is an alternative way of managing type II diabetes while improving insulin sensitivity. Medicinal plants are rich in therapeutic phytochemicals which possess hypoglycemic properties. Therefore, it could be speculated that the glycemic impact of diet can be reduced by adding hypoglycemic plant ingredients without altering the sensory properties of food. The main aim of this review is to discuss dietary interventions to manage diabetes and summarize available information on the hypoglycemic properties of four prime herbs of Asian origin. This article collected, tabulated, and summarized groundbreaking reveals from promising studies. This integrative review provides information on the hypoglycemic properties of ginger, Indian gooseberry, cinnamon, and turmeric and discusses the possibility of those herbs reducing the glycemic impact of a diet once incorporated. Further research should be done regarding the incorporation of these herbs successfully into a regular diet.

Background and Aim: Basal insulin combined oral therapy consisting of insulin and oral anti-diabetic drugs (OADs) is recommended for type 2 diabetes uncontrolled on OADs. There is a lack of clear evidence and recommendations on the combined use of basal insulin analogues to more than one OADs (glimepiride plus metformin) in effective control of glycemic parameters and its safety in terms of reduced hypoglycemic events, weight gain and cardiovascular risk. In this context, a group of clinical experts discussed the utility of basal insulin combined oral therapy with metformin and glimepiride in the current era. Methods: The clinical experts discussed and provided their inputs virtually. The expert panel included clinical experts comprising endocrinologists and diabetologists from India and Nepal. Results: The panel thoroughly reviewed existing literature on the subject and proposed clinical evidence and practice-based guidelines. Conclusion: These current clinical practice guidelines highlight the efficacy and safety of basal insulin combination therapy with various available basal insulins including neutral protamine hagedorn, detemir, glargine and degludec in addition to metformin and glimepiride therapy.

Aims: The present study aimed to compare the pregnancy outcomes, efficacy, and safety of faster aspart with insulin aspart among Indian women with gestational diabetes. Background: In several countries, fast-acting insulin aspart (faster aspart) has been approved for use in pregnancy. There is a lack of data related to maternal glycemic control and fetal and perinatal outcomes with faster aspart in gestational diabetes among the Indian population. Objective: To compare and evaluate the efficacy and safety of faster aspart and insulin aspart in the management of gestational diabetes. Methods: This retrospective study evaluated the medical records of 60 pregnant women diagnosed with gestational diabetes and managed with faster aspart or insulin aspart at a tertiary care center, between March 2019 and September 2020. Self-monitored blood glucose levels recorded at 4 timepoints (fasting, and 1 hour post breakfast, lunch, and dinner) during 6 consecutive days any time before delivery were analyzed. Pregnancy and neonatal outcomes across both groups were compared. Results: The mean postprandial glucose value following dinner was significantly lesser in the faster aspart group compared to the insulin aspart group (123.61 ± 2.52 mg/dL vs. 125.87 ± 2.98 mg/dL, respectively; p=0.0024). Women in the faster aspart group had significantly lower glycemic variability (fluctuations). Lesser number of hypoglycemic events were noted in the faster aspart group (10 vs. 20; p=0.0595). Conclusion: Faster aspart was associated with better glycemic control compared to insulin aspart among women with gestational diabetes. Further large-scale studies are needed to validate the outcomes.

Over the last century, there has been a gradual but sustained increase in life expectancy globally. A consequence of increased life expectancy is an associated rise in the prevalence of agerelated chronic debilitating neurodegenerative disorders, such as Alzheimer's disease (AD), Parkinson's disease, Huntington's disease, and multiple sclerosis. These disorders, which are generally characterised by the loss of motor/sensory neurons and cognitive decline, have continued to confound researchers who are working tirelessly to define their pathogenetic mechanisms and develop effective therapies. In the last few years, there has been increasing evidence of the existence of a relationship between energy metabolism and neurodegeneration, with reports that type 2 diabetes mellitus increases the risk of AD. Evidence from preclinical and epidemiologic studies has associated dysmetabolism and dysmetabolic syndromes with the development of neurodegenerative changes. More recently, diabetes mellitus and energy dysmetabolism have been linked to the aetiopathogenesis of AD. Moreover, metabolic hormones, including ghrelin, leptin, insulin, and insulin-like growth factor (IGF)-1, have been reported to play key roles in the regulation of neuronal injury and loss in neurodegenerative diseases like AD. In this narrative review, we examine the current scientific evidence regarding the role of dysmetabolism (including diabetes mellitus and metabolic syndrome) in AD and how it impacts disease progression and the development of novel therapies in AD.

Cardiovascular disease and renal complications raise the risk of death and morbidity in patients with type 2 diabetes (T2D). Sodium/glucose cotransporter-2 inhibitors (SGLT2i) are a novel class of glucose-lowering drug that increases urine glucose excretion while decreasing blood glucose levels in type 2 diabetes patients by inhibiting glucose reabsorption. In the present article, we review the discovery and development of SGLT2i as a new T2D treatment approach for T2D; thereafter, we consider different cell-based methods for the evaluation of SGLT2i. Finally, we provide evidences from both clinical and experimental studies which bring up the cardio-renal protective effects of SGLT2i. We performed a literature search using PubMed, Google Scholar, and Web of Science to identify publications on preclinical and clinical studies of cardiorenal protective action of SGLT2i and their suggested mechanisms. SGLT2i have shown good effects in the improvement of cardiovascular and renal complications independent of glucose lowering effects. Besides controlling blood glucose levels, SGLT2i were found to exhibit therapeutic benefits on the kidney and cardiovascular system by lowering diabetic glomerular hyperfiltration, blood pressure (BP), body weight, uric acid concentrations, lipid peroxidation, inflammation, etc. As a result of their distinct mode of action, SGLT2i have emerged as a promising treatment option for T2D and maybe T1D due to their increased urine excretion of glucose. It has been demonstrated that SGLT2i have considerable protective effects on diabetic nephropathy (DN) and cardiomyopathy in well-designed experimental and clinical investigations.

Background: Diabetes mellitus (DM) is a metabolic disorder characterized by abnormally elevated levels of blood glucose. The hyperglycemic condition is caused by abnormalities in either insulin secretion, insulin action, or both. Two-thirds of diabetes-related deaths are caused by atherosclerotic cardiovascular disease (ASCVD). Objective: The purpose of this study was to determine the risk of ASCVD and related factors in type 2 DM patients in Medan, North Sumatra. Methods: We conducted a cross-sectional observational study. A total of 252 DM patients visiting primary health centers in Medan were recruited after fulfilling the inclusion and exclusion criteria. The level of risk of atherosclerotic cardiovascular disease (ASCVD) was determined by using ASCVD Risk Calculator. Data required to use this calculator are age, sex, race, total cholesterol, HDL-C, systolic blood pressure, diastolic blood pressure, history of diabetes, history of hypertension treatment, smoking history, and use of statins for anti-hyperlipidemia. The data were then analyzed with Chi-square Test (p < 0.0%) and processed with SPSS. Results: There were 59 (23.41%), 140 (55.56%), and 53 (21.03%) participants who had high, moderate, and low risks of ASCVD, respectively. Bivariate analysis showed significant association between risk of ASCVD with age, SBP, total cholesterol level, HDL-C levels, and duration of diabetes (p < 0.05). Meanwhile, gender and familial history not related to ASCVD risks among DM patients (p > 0.05). Conclusion: The risks for atherosclerotic complications of cardiovascular disease in type 2 DM patients in Medan were predominantly high. The variables related to ASCVD risks included age, gender, HbA1C, systolic blood pressure (SBP), total cholesterol levels, HDL-C, and LDL-C levels.

A diabetic foot ulcer is a chronic clinical manifestation of diabetes that exacerbates the condition of a patient and has a considerable socioeconomic impact. A diabetic foot ulcer (DFU) impacts around 25% of patients with diabetes mellitus at a certain point in their lives, and the underlying cause of the condition appears to be linked to neuropathic, ischaemic, and/or neuroischaemic pathologies. For the effective treatment of DFU, a variety of conventional treatments are used. However, in recent years, a range of innovative materials have been studied to bolster standard treatment tactics and promote the desired biological response by transcending the impediments of current wound healing approaches. Inorganic/organic hydrogel hybrids for tissue regeneration are among the most promising materials. This review article outlines the current treatment options for DFU, applications of hydrogel with an emphasis on wound healing, polymeric materials used to fabricate hydrogel, and the role of emerging technologies.

The prevalence of type 2 diabetes mellitus has been increasing worldwide. As the therapeutic options for type 2 diabetes mellitus have evolved over the last 2 decades, national and global guidelines related to type 2 diabetes mellitus pharmacotherapy issued by various organizations have tended to vary in their recommendations. This narrative review aimed to analyze the key recommendations by major global and national guidelines on the initiation of insulin therapy in patients with type 2 diabetes mellitus over the last 20 years. Strategies for insulin therapy for titration and intensification were also assessed. All guidelines recommend initiation of insulin (basal/ premixed/other formulations) when glycemic targets are not achieved despite lifestyle measures and oral antidiabetic drugs. In the recent decade, early initiation of insulin has been recommended when the glycated hemoglobin levels are >10% or blood glucose levels are ≥300 mg/dL (16.7 mmol/L). Initiation is recommended at a dose of 10 units or 0.1-0.2 U/kg. Titration is advised to achieve the optimal dosage, while intensification is recommended when glycemic targets are not achieved despite titrating to an acceptable level. Glucose monitoring at periodic intervals is recommended for adequate glycemic control. The guidelines further suggest that the choice of insulin should be individualized, considering the clinical status of patients with type 2 diabetes mellitus. The physicians as well as patients should be a part of the decisions made regarding the therapeutic choice of regimen, preparation, and delivery device.

Purpose: The purpose of this systematic review is to discuss the ideal frequency of Registered Dietitian-Nutritionist (RDN) contact required to improve glycemic control in patients with type 2 diabetes in the primary care setting. Methods: Researchers completed a literature search between April 1 and June 30, 2020. Researchers identified 184 studies and included seven studies for full-text analysis. Eligible studies were required to occur in a primary care setting, use A1C as an outcome measure, and use some form of education or contact with an RDN. Study quality was assessed using the NIH Study Quality Assessment Tool. Results: Compared to the usual care group of each study, increased contact with an RDN improved A1C lowering regardless of frequency (round-the-clock, monthly, biannually). The largest decreases occurred in the round-the-clockand quarterly touch groups. Studies varied in modality (inperson, telehealth, etc.) and type of intervention. The participants had A1Cs between 8.07% and 10.25% before intervention. With RDN contact of any frequency between provider visits and participants saw A1Cs decreased between 0.66% and 2.2%. Conclusion: Greater glycemic control in patients with type 2 diabetes in the primary care environment is linked to more frequent RDN contact than that advised by the American Diabetes Association Standards of Care.

Background: Type-1 Diabetes Mellitus (T1DM) is an autoimmune and heterogeneous disorder. In the present study, we aimed to examine whether there exists an association between serum CXCL10 (IP-10) level and its promoter polymorphism at position-1443 along with CXCL12 and its known SDF-1 3′ A genetic variant as an angiogenesis chemokine in T1DM patients. Methods: Blood specimens were collected from 209 unrelated T1DM patients and 189 healthy subjects. The DNA samples were extracted from the subjects and analyzed for CXCL10 and CXCL12 polymorphisms using PCR-RLFP. The serum concentrations of CXCL10 and CXCL12 were also analyzed with ELISA. Results: Following expert opinion and data analysis, we found significant differences between A/A, A/G, and G/G genotypes with A and G alleles of polymorphisms at position +801 (SDF-1α3′A) in CXCL12. No association was reported between CXCL10/-1443 promoter polymorphism and T1DM. In our assessment of promoter polymorphism, both T1DM patients and controls had GG genotypes in CXCL10/-1443. When patients were compared with controls, both serum CXCL10 and CXCL12 levels were found to be increased in type 1 diabetes with complications. Levels were not increased in patients without complications. Conclusion: Both CXCL10 and CXCL12 play fundamental roles in T1DM pathogenesis. Only the CXCL12 3′A (SDF-1α3′A) polymorphism is possibly necessary for the pathogenesis of T1DM, while the CXCL10-1443 promoter polymorphism is not.

Background: Diabetic mellitus is the main public health problem nowadays, and the burden is higher in developing countries. Different anthropologic literatures were published to integrate socio-cultural beliefs and biomedical practice for managing diabetes mellitus. The current study reviews anthropology perspectives on diabetic mellitus and the relationship between health, socio-cultural beliefs and biomedicine using literature around the globe. Methods: This review included published studies in electronic databases such as Pubmed, World Wide Science and Google scholar. Published studies from the search database were exported to reference manager software, Endnote version 7, to remove duplicate studies. We screened the title and abstract, then the full text per settled inclusion criteria, followed by a full-text review to find eligible studies. Studies without abstract and/or full text, unspecified reports, viewpoints and any systematic reviews and meta-analyses were excluded. The protocol for this review was sent for registration on the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD 237899. Results: The search has been collected a total of 72 studies in the world. Five articles were excluded due to duplication in each database. About 47 articles and 15 articles were excluded based on the title and abstract screen, respectively. After full-text reviews were assessed, one article was removed due to that comparative study, and finally, we have approved only 4 articles for systematic review. Conclusion: The review identified those beliefs about socio-cultural, spiritual and biomedical aspects of the causalities, symptoms, and treatment. As there were limited studies worldwide, we extracted data from a few countries, including Ethiopia. Almost all studies identified the sociocultural causalities of diabetes mellitus as “hereditary, uncertainty, feeding habit and GOD.” The socio-cultural beliefs of healing are also summarized as “GOD allows holy water in Ethiopia only by orthodox Christians, traditional plants like Shiferaw or moringa also believed only in Ethiopia study, exercise, diet selection.” All studies found that biomedical regimens were believed to bring healing congruent with socio-cultural beliefs.

Type 2 diabetes mellitus (T2DM) is a set of metabolic disorders specified by hyperglycemia as a result of abnormalities in insulin secretion or sensitivity. Chronic kidney disease (CKD) and cardiovascular disease (CVD) are the widespread co-morbidities of T2DM and share risk factors for onset and progression. Despite numerous mono- and combination therapies exist, the progression of diabetes complications remains a global health concern. Treatment options for diabetic- CKD and CVD include drugs targeting hyperglycemia, hypertension, albuminuria, hyperlipidemia and the renin-angiotensin aldosterone system (RAAS). The sodium-glucose co-transporter 2 channel (SGLT2) is abundantly present in proximal tubules of the kidney and its capacity to recover glucose and sodium from the glomerular filtrate limits urinary glucose and sodium excretion. SGLT2 inhibitors (SGLT2i) reduce sodium and glucose reabsorption in the proximal and thus increase urinary glucose excretion in T2DM. SGLT2i monotherapy can improve but dual SGLT2/RAAS inhibition or SGLT2i along with other classes of drugs are more effective in protecting the kidneys and the cardiovascular system in patients with and without diabetes. Combinations such as empagliflozin and linagliptin, ertugliflozin and metolazone, dapagliflozin and sacubitril- valsartan and many more show promising results. Here, we have reviewed the ongoing and completed clinical trials, addressed current theories, and discussed necessary future research to explain the possible risks and benefits of using an SGLT2i alone and in combination with existing antidiabetic drugs and drugs acting on the cardiovascular system.

Background: Diabetes foot ulcers (DFU) are among the most common complications in diabetic patients, leading to amputation and psychological distress. This mini-review covers the general physiology of ulcer healing as well as the pathophysiology of DFU and its therapies. Only a few treatments have been sanctioned and numerous compounds from various pharmacological groups are now being tested at various stages for the prevention and treatment of DFUs. Objective: The main objective of this mini-review is to give concise information on how diabetes mellitus impairs the healing of chronic ulcers by disrupting numerous biological systems of the normal healing process, resulting in diabetic foot ulceration, and the current therapeutic approaches. Methods: A review of accessible material from systemic searches in the PubMed/Medline, Scopus, Cochrane Database of Systematic Reviews, published review articles, and Clinical Trials databases (US National Library of Medicine) with no period of limitation was conducted. Results: The treatment of DFUs comprises wound dressings, use of matrix metalloproteinase inhibitors in wound dressing, antibiotics, skin substitutes, pressure off-loading growth factors and stem cells, gene therapy, topical oxygen therapy, etc. Conclusion: The majority of these treatments are aimed at treating diabetic foot ulcers and preventing diabetic wounds from becoming infected. Yet, there is no single therapy that can be advised for diabetic foot ulcer patients. Future treatment strategies should be considered an appropriate treatment option for persistent wounds.

Background: Cognitive and motor deficits intertwined with type 2 diabetes mellitus (T2DM) alter walking patterns of the individuals. As walking is combined with various challenging cognitive tasks in daily activities, dual task testing is a promising avenue for gait evaluation and fall prediction in various conditions. However, there is a lack of clarity on the appropriate clinical measures for dual task gait evaluation in T2DM individuals. Objective: The present study aims to review and identify the appropriate clinical measures for dual task gait evaluation in T2DM. Methods: Electronic databases of PubMed, CINAHLPlus and scholarly platforms were searched to identify the relevant articles. Review has included studies which have subjects with T2DM, dual task testing as a part of evaluation, has used clinical measures to assess dual task gait and was available in English. Results: 16 articles met the inclusión criteria. Four studies used cognitive timed up and go test (TUG), four studies used walking while talking test; one study used extended TUG; one study used walking and remembering test;one study used instrumented TUG along with manual TUG and arithmetic subtractions; two studies used inertial sensors for gait evaluation along with backword counting; one study used two dimensional video analysis for gait along with verbal fluency task and calculation; one study used TUG with arithmetic additions task; one study used Manual TUG and arithmetic subtraction task while walking on GAITRITE walkway. Conclusion: The studies show a lack of valid and reliable clinical measures for dual task gait evaluation in T2DM.